CITY OF OSCEOLA
Employment Application
APPLICANT INFORMATION
Last Name
Street Address
City
Phone
First
M.I.
Date
Apartment/Unit #
ZIP
State
E-mail Address
Social Security No.
Desired Salary
Date Available
Position Applied for
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
YES
NO
Have you ever worked for this company?
YES
NO
If so, when?
Have you ever been convicted of a felony?
YES
NO
If yes, explain
EDUCATION
High School
Address
From - To____________
Did you graduate?
YES
NO
Degree
College
Address
From
To
Did you graduate?
YES
NO
Degree
Other
Address
From
To
Did you graduate? YES
NO
Degree
REFERENCES
Please list three professional references.
Full Name
Company
Address
Relationship
Phone-
Relationship
Phone-
Relationship
Phone-
PREVIOUS EMPLOYMENT
Company
Address
Job Title
Responsibilities
Phone ( )
Supervisor
Starting Salary $
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone
()
Address
Supervisor
Job Title
Starting Salary $
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
Company
Phone (
)
Address
Supervisor
Starting Salary $
Job Title
Responsibilities
From
To
Reason for Leaving
May we contact your previous supervisor for a reference?
YES
NO
MILITARY SERVICE
Branch
Rank at Discharge
If other than honorable, explain
Ending Salary $
Ending Salary $
Ending Salary $
From - To:
Type of Discharge
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature
Date
The City of Osceola is an Equal Opportunity Employer
210 Olive Street
POB 561
Osceola, Missouri 64776
417.646.8421